Working in partnership with the Rwandan Ministry of Health, the Rwanda Heart Foundation, and select global partners, Team Heart will address the burden of cardiac disease with the following goals:
- Establish a sustainable regional center of excellence in cardiac care, including cardiac surgery, a heart catheterization lab, rehabilitation and prevention, research and education in partnership with Rwanda local partners.
- Address the suffering of adolescents and young adults afflicted with advanced rheumatic heart disease in Rwanda with surgical intervention to return to productive and fulfilling life.
- Prevent advanced rheumatic heart disease through a combined effort of surveillance, prevention, education and early intervention. This will prove to be an example of an effective, countrywide intervention against rheumatic heart disease that can inspire a scalable model in the region.
- Support advocacy and poverty reduction initiatives for the population of marginalized individuals who suffer from chronic heart disease and the resulting impact on their ability to support themselves and their family.
Cardiac disease continues to be the leading cause of death in the world. Not a great deal is known about heart disease in Rwanda because of the lack of diagnostic and treatment options which currently exist. We do know that rheumatic heart disease (RHD) is the leading cause of cardiac hospitalizations in one population at the teaching hospitals. We also know that despite the world knowing that every country in the world has congenital heart disease (CHD) of 8-12/1000 of live births, that figure is not seen in Rwanda and most likely contributes to under five mortality, due to lack of basic diagnostic ability at birth and immunization clinics. Coronary ischemic heart disease, (CAD) the leading cause of death world wide is largely unrecognized in Rwanda and is most often identified in the private office of a cardiologist, suggesting the diagnosis is available to those who can pay for it. In the public sector, an EKG machine, key to CAD diagnosis is found in only 5 hospitals country-wide. There is no cath-lab in the country currently, and only 4 hospitals have capability do diagnostic cardiac echocardiogram.
Team Heart works with the Rwandan Ministry of Health, and the Rwanda Heart Foundation.
Team Heart, with representatives from Cardiac Surgery, Cardiology, Anesthesiology, Nursing and volunteers from 15 states in USA and Canada, in collaboration with the Rwandan Ministry of Health and the Rwanda Heart Foundation (RHF), enter year thirteen of this project designed to address one the most common heart problems in Africa: rheumatic heart disease. Heart disease in sub-Saharan Africa continues to represent one of the consequences of a generation of healthcare divestment. Rheumatic heart disease leaves young adults suffocating for years on the brink of death, a result of heart valve injury from untreated streptococcal infections. Early intervention with long-term penicillin protection could prevent heart failure in most of these patients. Even for the most neglected cases, however, prompt surgical intervention would restore a more productive life to those previously deprived of primary care.
Bringing Cardiac Care to Rwanda
The Ministry of Health requested assistance in 2007, to help integrate rheumatic heart disease control into their national health agenda. A comprehensive program, now in year thirteen, requires simultaneous initiatives at three levels. First, to address the suffering of those with advanced disease, Rwanda and partners must continue to develop local capacity for cardiac surgery by supporting and mentoring the surgical, anesthesia and nursing staff and providing the post operative care needed. Second, to protect those with milder forms of rheumatic heart disease from disease progression, Rwanda must begin registry-based penicillin prophylaxis programs. Third, to combat the source of rheumatic fever (streptococcal infection), Rwanda must extend nursing algorithms for throat and skin infections to the basic health center level.
Establishing a Cardiac Care Center in Africa
While most developed countries have nearly eliminated rheumatic fever through penicillin prophylaxis programs, no sub-Saharan African country has successfully accomplished this goal. A recent survey found only a handful of centers capable of performing cardiac surgery safely in Africa; almost all located in South and North Africa, compared with more than 4,000 such facilities in North America. With 16-20 million people affected by rheumatic heart disease globally, sub-Saharan Africa has almost half of the estimated 2.4 million school-aged children newly affected by the disease.
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Following the genocide in 1994, war torn Rwanda’s medical care delivery infrastructure lay in shambles. Few physicians and nurses remaining in the country survived the genocide. Providing the most basic medical care was difficult; today less than 750 physicians and 6000 nurses remain to provide care for more than 12 million. Even twenty years later, the numbers of physicians and nurses have increased at very slow pace. Hospitals and medical clinics were also destroyed during the war and had to rebuild with very limited human and fiscal resources.
Today patients with advanced rheumatic heart disease still languish, hospitalized when possible during acute illness, but rarely receiving the opportunity for transfer for outside the country for surgical care. At the same time, few of those with less severe heart damage who should be receiving the benefits of penicillin prophylaxis actually do so. In 2007, Rwanda joined other African countries in a call to join the fight against rheumatic heart disease. As part of the ASAP initiative (Awareness, Surveillance, Advocacy, and Prevention), Rwanda should be positioned to take a leading role in the control of this killer. Despite the determination, dedication and enthusiasm of local caregivers, lack of human and financial resources at the national level prevents the realization of this possible intervention..
"I am thankful to Team Heart for saving my life and allow me to return to my studies energetically and it does me proud to be studying public health"
“I consider being a part of Team Heart to be the biggest achievement in my nursing career, and one of the best parts of my life!”
“After I returned from Rwanda, each time I passed my to do list, my pencil hovered to cross off Rwanda--I could not do it. Rwanda was not finished.”
"Rwanda can eradicate rheumatic heart disease in a generation-it is an achievable goal"